Abstract
To elucidate the rate and risk factors of HBV reactivation in patients with chronic HBV infection with low replicative state and resolved HBV infection undergoing allogenic/autologous hematopoietic stem-cell transplantation (HSCT) in Korea. The medical charts of 506 patients who underwent allogenic/autologous HSCT from January 2008 to December 2013 were analyzed retrospectively. We examined the reactivation rate and variables related to the risk of HBV reactivation, with a median follow-up period of 41.8 (1-245)months. Univariate analysis was used to identify any factors associated with HBV reactivation. Factors that were significant in the univariate analysis were entered into a stepwise multivariate analysis to find the most significant risk factors associated with HBV reactivation. The reactivation rate of HBV in patients who underwent HSCT was 4.2% (21/506). In subgroup analysis, the HBV reactivation rate (14.3%) was the highest among HBsAg(+) patients (5/35). The reactivation rate of HBV in patients with resolved HBV infection [HBsAg(-)/HBcAb(+) with or without anti-HBs antibody] was 5.9% (10/171). In univariate analysis for risk factors of HBV reactivation in patients who underwent HSCT, initial detectable HBV DNA (p=0.004), age (≥60years) (p=0.012), recipient hepatitis B surface antigen-positive (HbsAg)(+) before HSCT (p=0.004), recipient hepatitis B surface antibody-negative (HBsAb)(-) before HSCT (p=0.005), recipient hepatitis B core antibody-positive (HbcAb)(+) before HSCT (p=0.013), and donor HBsAg(+) (p<0.001) were associated with reactivation of HBV. In multivariate analysis, significant risk factors of HBV reactivation in patients who underwent HSCT were old age (≥60years) (p=0.032) and donor HBsAg(+) (p=0.026). Old age (≥60years) and donor HBsAg(+) were risk factors for HBV reactivation in HSCT patients. Preemptive antiviral treatment should be considered in these patients.
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